Ganglion Impar block through Transsacrococcygeal Approach For Management Of Chronic Perineal Pain

Dipika Patel, Nita Gosai

Department of Anaesthesia Gujarat Cancer and Research Institute, Civil Hospital, Ahmedabad, Gujarat India

The ganglion Impar is an unpaired sympathetic structure located at the level of the Sacrococcygeal joint. The modified technique replaced the previously using technique of the Impar block via the horizontal approach through the anococcygeal ligament. Modified technique of Ganglion Impar block through transsacroccygeal approach is easy to perform and give maximum pain relief with margin of safety.
Aims and objectives To study, 1) Ease and complications of Impar block through trans- sacrococcygeal approach 2) The analgesic efficacy of Impar block, 3) Duration of analgesic effect of Impar block
Method In this retrospective study,15 patients who had chronic perineal pain had given ganglion Impar block.., The ganglion Impar block was given through trans-sacrococcygeal approach, After written and informed consent, patient was asked to lie down on his abdomen, facing down with a pillow under the pelvis to help flatten out the lower lumber spine’s natural curvature. Skin was infiltrate with local anaesthetic, after proper aseptic precautions. The needle is advanced under fluoroscopy guidance until correct needle placement is obtained. Once position is confirmed, therapeutic block is performed with administration of 2ml of 100% absolute alcohol after confirming 50% reduction in VAS from baseline with diagnostic block (0.125% Bupivacaine 5 ml). Attempts of procedure were recorded in all patients. VAS was assessed after 12 and 24 hours. Patients were discharged after 24 hours, asked to report every week and whenever VAS is more than 4 for 3 months Result Fifteen patients with advanced cancer with perineal pain who were not responding to pharmacotherapy treatment received a neurolytic ganglion Impar block through trans-sacrococcygeal approach. Thirteen Patients were not needed any medication. Two patients were needed Tab Morphine after 2 weeks of block. All the blocks were effective without any adverse events. All the patients had significant pain relief during 3 months follow up (P<0.001compared to baseline).Conclusion Ganglion Impar block through trans-sacrococcygeal approach is feasible technically and safe. It is recommended for chemical neurolysis or radiofrequency ablation of the ganglion Impar for chronic perineal pain.

Keywords: chronic perineal pain, Ganglion Impar block, trans-sacrococcygeal approach

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How to cite this article:
Dipika Patel, Nita Gosai.Ganglion Impar block through Transsacrococcygeal Approach For Management Of Chronic Perineal Pain .Global Journal of Anesthesia and Clinical Research, 2020, 3:7

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